Topics Related to Medicaid Managed Care

NC Medicaid Behavioral Health Services Rate Increases

Some services will receive rate increases effective Jan. 1, 2024

Provider and Member Flexibilities for NC Medicaid Expansion Launch

Several flexibilities will be available on Dec. 1, 2023, to ease provider burden and ensure Medicaid expansion beneficiaries receive needed care.

Legislated Medicaid Provider Rate Increases: Durable Medical Equipment and Ambulatory Surgical Centers

Updates on NC Medicaid programs that received legislative increases to service rates in the Current Operations Appropriations Act of 2023

Reprocessing of Outpatient Claims with Revenue Code 025x and 063x and Missing Required Data

Starting in November 2023, Standard Plans and Medicaid Direct will reprocess claims without appropriate documentation of required codes.

Maternity Coverage and Service Reimbursement Updates

NC Medicaid is implementing changes due to Session Law 2023-14 and to implement additional clinical best practices for maternity care.

Legislated Medicaid Provider Rate Increases: Skilled Nursing Facilities (SNF), Personal Care Services (PCS), and Private-Duty Nursing (PDN)

This bulletin provides updates on NC Medicaid programs that received legislative increases to service rates in the Current Operations Appropriations Act of 2023 (SL 2023-134).

Update: Retroactive Disenrollment from NC Medicaid Managed Care

Providers should submit claims for dates of service that now fall in NC Medicaid Direct.

NC Medicaid to Remove Copays for HIV Antiretroviral Medications

Effective Nov. 1, 2023, NC Medicaid will remove all copay requirements for antiretroviral medications which decrease viral load in patients with HIV.

NC Medicaid Managed Care Provider Update – Oct. 2, 2023

Includes provider recredentialing/reverification, Medicaid expansion, Tailored Plan implementation and more.

Hospital at Home Program Re-Launching for NC Medicaid

Hospital at Home Program Re-Launch: NC Medicaid will cover the Acute Hospital at Home Program starting Nov. 1, 2023.

NOTE: This Bulletin was revised on April 2, 2024 to correct an error. In the original version, published Sept. 27, 2023, it was stated that the Hospital at Home Program had a previous end date of March 31, 2021. Prior to relaunch, the previous end date was March 31, 2022, as corrected and explained below.